title: Surgical treatment of type IV-A choledochal cyst in a single institution: children vs. adults.
abstract: BACKGROUND
  The treatment of type IV-A choledochal cyst is particularly difficult and remains a challenge because of the rareness and the various presentations of the disease involving not only the extrahepatic but also the intrahepatic biliary tract. The purpose of this study is to analyze our clinical experience for surgical treatment of type IV-A choledochal cyst, and compare between children and adults.
  
  
  METHODS
  During a 10-year period of time (2000-2010), clinical data of 81 consecutive patients with type IV-A choledochal cyst were retrospectively analyzed. We divided these patients into two groups, the child group (age ≤ 18 years) and the adult group (age >18 years). According to whether the patient received additional liver resection, patients were divided into a extrahepatic cystectomy (EHC) group and an additional liver resection (LR) group. The long-term outcomes after surgery were evaluated in two groups.
  
  
  RESULTS
  Of all 81 patients, there were 17 children and 64 adults; 16 children and 35 adults belonged to EHC group, one child and 29 adults belonged to LR group. The morbidity of biliary stricture and/or lithiasis in the adults was significantly higher than that in the children (p = 0.041 < 0.05). In the EHC group, the reoperation rate of adults was significantly higher than that of children (p = 0.019 < 0.05). For adult patients, the morbidity of biliary stricture and/or lithiasis and the reoperation rate in EHC group was significantly higher than that in LR group (p = 0.037 < 0.05 and p = 0.026 < 0.05 respectively). Five adults were found to have cholangiocarcinoma within a follow-up period, while no child was found to. However, for adult patients, no significant discrepancy was observed between EHC group and LR group (p = 0.366 > 0.05).
  
  
  CONCLUSIONS
  The present study suggests that the children have better outcomes than adults for patients with type IV-A choledochal cyst after EHC, while LR brings better outcomes than EHC for adult patients.
authors.affiliation: Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Zheng
authors.forename: Wanqing
authors.initials: W
authors.lastname: Gu
authors.forename: Hongtian
authors.initials: H
authors.lastname: Xia
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Huang
authors.forename: Bin
authors.initials: B
authors.lastname: Liang
authors.forename: Tao
authors.initials: T
authors.lastname: Yang
authors.forename: Shizhong
authors.initials: S
authors.lastname: Yang
authors.forename: Jianping
authors.initials: J
authors.lastname: Zeng
authors.forename: Jiahong
authors.initials: J
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000714:Anastomosis, Surgical; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D001652:Bile Ducts / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018281:Cholangiocarcinoma / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D015529:Choledochal Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult; Child; Cystectomy; Liver resection; Type IV-A choledochal cyst